What happens if my condition gets worse after I settle my workers’ compensation case?

Question

A few years ago, I was working in a shipping warehouse when a coworker caused a heavy box to fall on me. I had some pretty severe back pain and received treatment for about a year, mostly injections and physical therapy. At the time, my doctor said that I wasn’t a candidate for surgery and I settled my workers’ compensation case. In the last few months, though, my back pain has been worse than ever. I saw my doctor, who thinks that the pain is due to my work injury and recommends surgery. Can I get compensated through workers’ comp?

Answer

Depending on the type of settlement you entered into, you may be able to get reimbursed for the cost of the surgery and other necessary treatment. If your workers' comp settlement specified that you would be compensated for future medical expenses, you can submit your bill for surgery or other medical treatment for reimbursement. But, if your settlement was a full and final release of all claims with no right to future medical expenses, you won’t necessarily be entitled to the cost of your treatment. The only way you can get reimbursed in this situation is if your state has a law making it illegal for workers to waive their right to future medical care.

Even if your settlement ensured that you would be entitled to future medical costs, if you want to obtain temporary disability or permanent disability benefits, you’ll need to reopen your workers’ compensation case. Most states allow injured workers to reopen their claims if there’s medical evidence that their injuries have gotten significantly worse (and there was no other injury or other intervening cause). Typically, you must file to reopen a workers’ compensation claim within a certain amount of time, either from the date of your injury or from the last date you received workers’ comp benefits. Each state has its own time limits and other restrictions on reopening a claim.

If you signed a full and final release of all claims, you probably won’t be able to reopen your case to get disability benefits or reimbursement for medical costs. In most states, this type of settlement means that you’re giving up the right to bring any future claims having to do with your injury. In many states, you can get around this only by proving fraud – that is, that your employer intentionally misrepresented the terms of the settlement. Because it can be difficult or impossible to reopen a closed claim, injured workers should think carefully before accepting any type of settlement.

Of course, if your back pain qualifies as a “new” injury, you can file a new workers’ compensation claim. To qualify, there would have to be some type of incident or other working conditions that caused the new injury. Because it can be difficult to tell whether an injury is new or not, you should consult with a workers’ compensation attorney before filing a claim.

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